MEDICARE: JOHN GLEN CARSON NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	15232	TN

General Provider Information

NPI Number	:	1285943605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GLEN CARSON NP-C

Provider Business Mailing Address
First Line	:	5304 CANE RIDGE RD
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-3839
Country	:	US
Telephone Number	:	615-846-4545
Fax Number	:	615-717-6239

Provider Business Practice Location Address
First Line	:	5304 CANE RIDGE RD
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-3839
Country	:	US
Telephone Number	:	615-846-4545
Fax Number	:	615-717-6239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	01/28/2025

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Directions to “ JOHN GLEN CARSON NP-C” Practice Location

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